- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.45 / $15,881.00 / $29,816.64
| Facility | | $1,010.45 | $15,881.00 | $29,816.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,110.00 / $11,249.00 / $30,091.00
| Facility | | $3,110.00 | $11,249.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.94 / $1,067.96 / $1,232.27
| Facility | | $837.94 | $1,067.96 | $1,232.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.32 / $3,833.32 / $3,833.32
| Facility | | $3,833.32 | $3,833.32 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |